- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $4,466.84 / $10,471.29
| Facility | | $1,148.15 | $4,466.84 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,047.13 / $2,691.53
| Professional | | $776.25 | $1,047.13 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $5,495.41 / $12,882.50
| Facility | | $3,388.44 | $5,495.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $2,089.30
| Professional | | $676.08 | $851.14 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,995.26 / $8,912.51
| Facility | | $1,148.15 | $1,995.26 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $4,786.30 / $53,703.18
| Facility | | $1,380.38 | $4,786.30 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,548.82 / $3,715.35
| Professional | | $602.56 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,513.56 / $2,884.03
| Facility | | $870.96 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,047.13 / $1,548.82
| Professional | | $776.25 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,122.02 / $2,041.74
| Professional | | $707.95 | $1,122.02 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $50,118.72 / $75,857.76
| Facility | | $933.25 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $1,096.48 / $1,778.28
| Professional | | $398.11 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $4,897.79 / $10,232.93
| Facility | | $2,398.83 | $4,897.79 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,071.52 / $2,630.27
| Professional | | $630.96 | $1,071.52 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,096.48 / $2,818.38
| Facility | | $660.69 | $1,096.48 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,096.48 / $2,630.27
| Professional | | $660.69 | $1,096.48 | $2,630.27 |